Repro/GU

Identify the two major urogenital primordia in the embryo (4-5 weeks).

Describe the significance of pronephros, mesonephros, and metanephros on kidney development, and how development of the permanent kidney accounts for clinical conditions such as horseshoe kidney, pelvic kidney, and multiple renal arteries.

Identify the common male/female primordia at the 8-week "indifferent stage" and the adult UG structures they become.

Describe the embryological/anatomical basis of ectopic pregnancy, hypospadius, cystic structures around the testis or ovary, and fistulas/cysts/sinuses related to abnormal UG sinus development.

Describe the major histological features of the female reproductive organs - epithelial types and nature of the mucosa/submucosa and muscularis.

Describe the steps in oocyte development (timing of meiotic divisions, etc.) and the difference between primordial, primary, secondary, and mature (Graafian) follicles. Indicate the hormones that stimulate follicle development and trigger ovulation.

Describe the origin, function, and two cell types of a corpus luteum.

Identify the menstrual, proliferative, and secretory phases of the uterine mucosa (endometrium) and the hormonal basis for changes in the uterine lining. Describe the histological differences between cervix and body.

Describe the origin and structure of a placental villus and placental membrane (maternal/fetal blood barrier).

Describe the unique histological features of the vagina and the histological basis of interpreting a PAP smear.

Identify the histological features related to the production and secretion of milk by the mammary gland.

Describe how the breast changes during the menstrual cycle, during pregnancy, and during old age.

Differentiate chromosomal, gonadal and phenotypic sex.

Describe the known roles of genes in gonadal differentiation, particularly SF1, DAX, AMH, SOX9, and SRY.

List the analogous structures of male and female external genitalia.

Describe the role of dihydrotestosterone in the development of external genitalia.

Describe the chromosomal makeup, external and internal genitalia, and abnormalities of the genitalia in the following disorders: Kleinfelter syndrome, Turner syndrome, mixed gonadal dysgenesis, 46, XY disorders of gonadal dysgenesis, 5-alpha reductase deficiency, and 21-hydroxylase deficiency.

Apply the knowledge of sexual differentiation to determine the expected findings in an individual with a disorder of sexual development.

Identify the social and medical challenges of caring for individuals with disorders of sexual development.

Describe the components of the female reproductive system.

Summarize the function of the hypothalamic-pituitary-ovarian axis.

Summarize the gonadotropin releasing hormone regulation of gonadotropin secretion.

Explain the production of sex hormones.

Explain the estradiol feedback on gonadotropin secretion.

Differentiate the endocrine causes of female reproductive dysfunction.

Summarize the hormonal changes characteristics of different categories of reproductive disorders.

Explain the pathogenesis of the reproductive abnormalities of PCOS.

Describe the metabolic abnormalities of PCOS.

List the diagnostic criteria for PCOS.

List the common causes of secondary amenorrhea.

Describe how the normal function of the hypothalamic pituitary-ovarian axis is altered with the common causes of anovulation/amenorrhea.

Apply a simple paradigm to make a correct diagnosis in a patient with amenorrhea.

Describe effective therapeutic approaches to the infertile couple.

Define infertility.

Describe the differential diagnosis of infertility.

Describe the modern diagnostic approach to infertility.

Describe effective therapeutic approaches to the infertile couple

Describe the various contraceptive methods that affect each site of the female genital tract (vagina, cervix, endometrium, fallopian tube, and ovary), and the specific mechanism(s) used to prevent conception.

In the context of counseling a patient with medical problems that absolutely preclude pregnancy, explain the benefits of long-acting reversible contraception and identify those methods which are considered: LARC.

Using the concept of first pass metabolism, explain why oral combined hormonal contraception is associated with increased risk of thromboembolic complications compared to trans-dermal and vaginal combined hormonal formulations.

A patient complains of new acne on an oral contraceptive pill containing progestin, levonorgestrel. Formulate and explanation to her as to why a drospirenone-containing pill might help reduce her acne.

Compare the side effect profile of the copper-containing IUD to the progestin-releasing IUD based on their effects on the endometrium.

List the functions of the placenta.

Describe the process of normal implantation.

Describe the development of the placenta, especially focusing on the roles of cellular differentiation and vascular development.

Explain how the placenta can maintain extensive fetal growth in the third trimester despite only a relatively small increase in placental size.

Describe the process and importance of remodeling of the maternal spiral arteries.

List the gross and histologic features of a normal placenta.

Differentiate maternal and fetal compartments of the placenta.

Compare and contrast the features of ascending and hematogenous infection in the placenta and fetal membranes.

Describe abnormalities of uteroplacental and fetoplacental vasculature and their complications: preeclampsia, abruption, fetal thrombotic vasculopathy.

Distinguish between dichorionic and monochorionic placentation and compare and contrast formation and complications of these twinning patterns.

Distinguish between the pathologic findings in partial and complete hydatidiform mole.

Describe how design of the pelvis is related to obstetrics and bipedal locomotion.

Explain how the arrangement of ligaments of the sacrum relates to force transmission through the pelvis.

Describe how the pelvic diaphragm differs from the urogenital diaphragm.

Indicate the path of urine flow from the pyramids to the exterior of the body and indicate where kidney stones commonly lodge.

Relate pelvic development from splanchnopleure and somatopleure (gut vs. body wall) to the organization of muscles, nerves, blood supply, and lymphatic drainage. Define hemorrhoids and describe how they relate to venous drainage and portal hypertension.

Explain how sympathetic, parasympathetic, and visceral sensory neurons get to the pelvic plexus.

Explain the maternal physiologic chanegs in pregnancy as a basis of how that can affect disease presentation.

Recognize the Unique features of fetal physiology.

Describe normal labor and delivery.

Describe and recognize common abnormal processes that affect pregnancy outcome.

Identify the etiologies of preterm birth and the risks related to prematurity.

Define the perineum, its boundaries, and identify the structures that traverse it.

Describe the difference between the urogenital and pelvic diaphragms. Define the central tendon of the perineum and identify the structures that attach to it.

Define the superficial and deep perineal pouches and identify their contents. Describe Colles' fascia and its attachments and relations.

Identify the parts of the male and female genitalia, their blood supply and innervations, and how they relate to the two diaphragms. Describe the ligaments of the uterus and ovaries and the basic supporting structures for all pelvic/perineal viscera.

Describe the structures cut in a median and mediolateral episiotomy, the muscular cause of uterine prolapse, the location and effects of nerve blocks, and the clinical significance of the rectouterine pouch.

Explain the pathology of gestational trophoblastic diseases.

Describe the genetics of hydatidiform moles.

Diagnose and develop a management plan for a hydatidiform mole.

Define gestational trophoblastic neoplasia.

Describe treatment options for gestational trophoblast neoplasia based on stage and risk assessment.

Summarize the most important reasons for gestational trophoblastic neoplasia treatment success.

Describe why and how gonadotropin releasing hormone and/or analogs are used diagnostically and for stimulatory and inhibitory effects.

Describe why and how gonadotropins are used therapeutically in males and females.

Describe why analogs of androgens, estrogens, and progestins can provide therapeutic advantages over the naturally occurring hormones.

Describe the relationship of the psychological effects of androgens, estrogens, and progestins to their therapeutic applications and side effects.

Describe the actions and applications of agents that inhibit gonadal hormone synthesis or action.

Describe the reproductive cycle and why estrogenic and progestational compounds can be effective contraceptives.

List indications for prenatal genetic diagnostic testing.

Describe principles of genetic carrier testing.

Describe the risks for aneuplodiy or single gene disorders for patients based on age, prior history, or screening results.

Recognize pedigree patterns consistent with hereditary gynecologic cancer syndromes.

Distinguish different types of spontaneous abortion when challenged with simulated clinical scenarios.

Describe in layman's terms to a classmate steps involved in performing uterine evacuation during the first trimester.

Describe in layman's terms to a classmate medical options for uterine evacuation during the first trimester.

Define menopause, menopause transition, and perimenopause.

List the cardinal signs/symptoms of the perimenopause.

Describe the clinical significance of menopause and your place as a role model in health promotion.

Describe indications for treatment of perimenopausal symptoms and basic treatment principles for prescribing hormone therapy.

Apply knowledge of menopause to clinical scenarios and begin to understand counseling and informed consent.

Describe the etiologic role that high risk HPV plays in the development of invasive cervical carcinoma.

Describe the protracted natural history of cervical dysplasia and the low rate of progression to invasive cervical carcinoma.

Identify the basic principles behind the pap test and high risk HPV testing.

Describe the two pathways of squamous carcinogenesis in the vulva 1) HPV related, 2) related to lichen sclerosus.

Compare and contrast lichen sclerosus and lichen simplex chronicus.

Contrast mammary Paget's disease with extra mammary Paget's disease.

Define the criteria that make the pap smear a successful screening tool for cervical cancer.

Apply risk benchmarking to contemporary pap smear/HPV results when presented with a clinical scenario.

Identify and describe the following vulvar lesions: lichen sclerosis, vulvar carcinoma, vulvar intraepithelial neoplasia, vulvar condyloma, dermatitis, melanoma.

Differentiate low-risk HPV lesions from high-risk HPV lesions with respect to etiology, natural history, and management.

To describe basic rmbryology, anatomy, and physiology of the breast.

To describe basic breast histology and the changes that occur over a woman's lifetime.

To describe the characteristics and histology of benign breast disease and describe the most common benign breast diseases.

Describe the tumor classification for four types of "ovarian tumors."

Describe the major histological features and molecular changes in type I and II ovarian carcinomas.

Describe the concept of fallopian tube in ovarian carcinogenesis and the key features of high grade serous carcinoma.

Differentiate the histogenesis of germ cell and sex-cord and stromal tumors.

Describe the range of histologic changes of endometrium in different hormonal status.

Connect the clinical and pathologic findings of uterine bleeding.

Describe the spectrum of estrogen-driven endometrium from proliferative, hyperplastic to neoplastic progression.

Describe the morphologic features of epithelial and mesenchymal neoplasms that arise at this site

Benign and Malignant Uterine Disease

Describe the role of somatic (pudendal), sympathetic, and parasympathetic nerves in urination and defecation.

Identify the mechanisms responsible for the continence and voiding phases of micturition and defecation.

Describe the sequence of events in the colon and anal sphincters occurring during reflexive defecation.

Describe the levels of CNS control of micturition and defecation, differentiating reflexive and voluntary control mechanisms.

Describe the innervation of sexual organs in men and women.

Outline the coordination of somatic, sympathetic and parasympathetic activity in sexual function.

Describe the sequence of events in male and female sexual arousal and climax.

Explain differences and similarities in male and female sexual function.

Identify and differentiate the 4 types of female sexual dysfunction.

Identify the multifactorial causes of FSD.

Describe how to conduct a professional sexual dysfunction interview.

Describe how to treat FSD.

Name the organs of the male reproductive system in correct anatomical sequence with respect to the passage of sperm, beginning with the testes.

Identify the major histological features and functions of the organs. Describe the process of ejaculation and the function and the clinical significance of prostate specific antigen.

Describe the structure of a spermatozoon at the electron microscopic level.

Describe the processes that occur in the seminiferous tubules, collectively known as spermatogenesis or gametogenesis (that includes spermatocytogenesis, meiosis, and spermiogenesis.

Describe the process of sperm maturation and capacitation, where they occur, and the timeframe for all of the events.

Describe the events and function of the acrosome reaction at fertilization and the ovum cortical reaction.

The learner will be able to list the available types of male contraception.

The learner will be able to state demographic factors that are associated with increased/decreased utilization of vasectomy.

The learner will be able to describe the risks and benefits associated with a vasectomy procedure.

The learner will be able to discuss the four different broad categories of sexual dysfunction.

The learner will be able to differentiate the three types of erectile dysfunction.

The learner will be able to compare and contrast the available behavioral, medical, and surgical therapies for ED.

The learner will be able to identify the medical co-morbidities that should be considered when a patient is diagnosed with erectile dysfunction ("reciprocal diagnosis").

Recite the core information on the epidemiology of prostate cancer.

Describe the methods for early detection of prostate cancer.

Describe the primary tumors.

Evaluate the patient for immediate treatment or active surveillance.

Recite the management options and be able to discuss the pros and cons of each.

Recognize the indications for multimodal primary therapy and adjuvant therapy and evaluate the need andoptiosn for salvage therapy.

1. Describe the major sexually transmitted disease syndromes. (MKS-1b) 2. Describe the microbiological characteristics of the major sexually transmitted pathogens. (MKS-1b) 3. Describe the disease manifestations caused by the sexually transmitted pathogens as well as tests and therapies used to diagnose and treat them. (MKS-1d, MKS-1e)

1. Identify basic epidemiologic trends (incidence, patterns of spread) for sexually transmitted infections (MKS-1f) 2. Describe how anatomic, biologic, social and behavioral factors affect STI acquisition and prevention (MKS-1b, CES-1) 3. Identify effective prevention efforts for the major STIs (MKS-1b,d,e,f) 4. List the impact of STI's on women's health and reproductive outcomes (MKS-1b) 5. Explain the mechanism of transmission and effective prevention strategies for STIs which are perinata

1. Recognize the symptoms and signs of a urinary tract infection (UTI) and interpret confirmatory diagnostic tests. (CMKS-1d, MKS-3c)

Understand why UTI occur and what can be done to prevent them.

3. Learn management strategies for treatment of UTI. (MKS1e)

Describe the normal stages of spermatogenesis.

Differentiate the clinical presentation of hypogonadotropic hypogonadism and hypergonadotropic hypogonadism in terms of reproductive health.

Describe the pathophysiology of varicocele in causing male factor infertility.

Identify appropriate laboratory testing for a male presenting for a fertility evaluation.

Describe when genetics testing is indicated in the evaluation of men with ssevere oligospermia/azoospermia.

Describe indications for and outcomes associated with microdissection testicular sperm extraction.

1. Identify the common congenital anomalies of the kidneys and ureters (MSK1a/knowledge) 2. Describe the radiolographic findings associated with anomalies of the kidney, ureters, and urethra (MSK1a/knowledge) 3. List the differential diagnosis of antenatal hydronephrosis and identify their initial management (MSK1a/knowledge) 4. Describe the most frequent causes of UPJ obstruction (MSK1a.knowledge) 5. Apply the Weigert-Meyer rule to predict the pathology associated with duplicated ureters (

1. Describe the epidemiology of depression during pregnancy and postpartum (MKS 1f) 2. Discuss risks of antidepressant use during pregnancy (MKS 1e) 3. Review risks of Major Depressive Disorder during pregnancy (MKS 1b) 4. Present data about breastfeeding and antidepressant use (MKS 1e) 5. Be aware of the impact of pregnancy on drug disposition and the need for antidepressant dose changes (MKS 1e) 6. Learn why the FDA categorization (ABCDX) for drugs in pregnancy should not be used to guide

1. Identify and name the major anatomic and histologic features of the prostate gland (MKS1a/knowledge) 2. Identify the predominant location in the prostate where BPH develops and describe how this fact relates to the symptoms and signs of BPH (MKS-1b) 3. Describe the distinctive epidemiological features and natural history of BPH (MKS-1b) 4. List the symptoms and signs of BPH (MKS1c&d/knowledge) 5. List the indications for treatment of BPH(MKS1e/knowledge and MKS3d/clinical reasoning) 6.

1. List the spinal cord level of nerve root origin providing parasympathic, sympathetic, and somatic neurologic input to the lower urinary tract (MKS 1a) 2. Define bladder compliance and describe how this can affect renal function (MKS 1a) 3. Describe the roll of the pontine micturition center in coordinating lower urinary tract function (MKS 1a) 4. Describe lower urinary tract impact of neurologic diseases above the pontine micturition center as well as at the cervical, thoracic, and sacral

1. Describe the different histological types of testicular tumors. (MKS-1b) 2. Describe the commonly used markers for testicular tumors. (MKS-1b) 3. Describe key diagnostic features of these tumors. (MKS-1d)

1. Describe the anatomy, presenting features, and management options for the commonly encountered benign scrotal masses. (MKS 1b, 1d, 1e) 2. Describe the anatomic abnormalities predisposing to testicular torsion, the common presenting signs/symptoms, useful diagnostic tests and the rationale underlying prompt surgical management. (MKS 1b, 1d, 1e) Describe the standard precepts of diagnosis, staging, and management of testicular, penile, & urethral tumors. (MKS 1d, 1e)